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NPI Code Detail

MEDICARE: KATHRYN BOAZ RUSSELL

MEDICARE: KATHRYN BOAZ RUSSELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11004745OTHERMANHP
2M18633OTHERMABCBS
30000023532OTHERMABMC
41004745OTHERMAFALLON
5042611055OTHERMATAX ID
61303287OTHERMAMBHP
799618201OTHERMANETWORK HEALTH

General Provider Information

NPI Number : 1649466681
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN BOAZ RUSSELL
Provider Business Mailing Address
First Line : 205 BURLINGTON RD
Second Line :
City : BEDFORD
State : MA
Zip : 01730-1406
Country : US
Telephone Number : 817-761-5078
Fax Number : 781-275-7207
Provider Business Practice Location Address
First Line : 205 BURLINGTON RD
Second Line :
City : BEDFORD
State : MA
Zip : 01730-1406
Country : US
Telephone Number : 817-761-5078
Fax Number : 781-275-7207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/24/2007
Last Update Date : 08/12/2019

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Directions to “ KATHRYN BOAZ RUSSELL ” Practice Location

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